| NPI | 1164749933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 100236) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D7755) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2022-09-07 |